Alarm Safety in a Regional Neonatal Intensive Care Unit PDF
Preview Alarm Safety in a Regional Neonatal Intensive Care Unit
Walden University ScholarWorks Walden Dissertations and Doctoral Studies Walden Dissertations and Doctoral Studies Collection 2015 Alarm Safety in a Regional Neonatal Intensive Care Unit Piper Probst Walden University Follow this and additional works at:https://scholarworks.waldenu.edu/dissertations Part of theNursing Commons This Dissertation is brought to you for free and open access by the Walden Dissertations and Doctoral Studies Collection at ScholarWorks. It has been accepted for inclusion in Walden Dissertations and Doctoral Studies by an authorized administrator of ScholarWorks. For more information, please [email protected]. Walden University College of Health Sciences This is to certify that the doctoral study by Piper Probst has been found to be complete and satisfactory in all respects, and that any and all revisions required by the review committee have been made. Review Committee Dr. Mary Tilbury, Committee Chairperson, Health Services Faculty Dr. Eric Anderson, Committee Member, Health Services Faculty Dr. Joanne Minnick, University Reviewer, Health Services Faculty Chief Academic Officer Eric Riedel, Ph.D. Walden University 2015 Abstract Alarm Safety in a Regional Neonatal Intensive Care Unit by Piper A. Probst MSN, University of Michigan, 1998 BSN, Michigan State University, 1992 Project Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Nursing Practice Walden University October 2015 Abstract Alarm fatigue is a practice problem that applies to hospitalized patients and the nurses who care for them. Addressing alarm fatigue is important to promote alarm safety and to decrease the risk of patient harm or death. The purpose of this study was to decrease alarm fatigue and improve alarm safety in a regional neonatal intensive care unit (RNICU). Guided by the conceptual model for alarm fatigue and alarm safety, this study addressed whether or not alarm management protocols designed to decrease false and nuisance alarms in the physiological monitoring of neonates improve alarm safety via decreased alarm burden and alarm fatigue as evidenced by statistically significant reductions in false and nuisance alarms. A quantitative, time series quasi-experimental design was used with 4 waves of data collection. One wave was baseline data collected preintervention, and 3 waves of data were postprotocol implementation to obtain an initial indication of sustainability. Alarm observation data collection sheets were developed and used to track numbers and types of alarms pre- and post-protocol implementation. The data analysis showed statistically significant decreases in both false alarms and nuisance alarms related to the physiological monitoring protocol and lead changing protocol. Overall, high protocol adherence was noted, and the total number of alarms per hour per bed was reduced by 42% (p < .001), 46% (p < .001), and 50% (p < .001) from baseline at Weeks 2, 4, and 6, respectively. Implications from this study include impact on practice and policy, direction for future study, and a call for social change to promote alarm safety in the care of neonates. Alarm Safety in a Regional Neonatal Intensive Care Unit by Piper A. Probst MSN, University of Michigan, 1998 BSN, Michigan State University, 1992 Project Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Nursing Practice Walden University October 2015 Dedication This work is dedicated to Elgin and Eli Probst, my teenaged sons who have been extremely supportive and understanding of my DNP studies. I believe they have gained an increased appreciation of the importance of homework, learned to become a bit more independent, and now appreciate that learning is truly a lifelong endeavor. They are wonderful sons, I am blessed to have them, and I love them beyond measure. Acknowledgments First and foremost I would like to acknowledge my husband, DeWayne. Thank you for all you have done to support me in this endeavor. I am looking forward to saying “yes” to date nights again instead of “I’m sorry. I need to write a paper.” I would also like to acknowledge my mom, Sandra Green. Thank you for all of your support and encouragement. I would also like to acknowledge neonatal nurse experts Kathleen Marble, MSN, RNC-NIC and Sarah Collins, BSN, RNC-NIC. This work would not have been possible without you and your nursing team. Thank you for your time and contributions. You make a difference every day in the work you do. Lastly I would like to acknowledge my DNP project chairperson and committee members, Mary Tilbury, Eric Anderson and Joanne Minnick. Thank you to Dr. Anderson and Dr. Minnick for serving on my project committee. Thank you to Mary for being my project chair and for all you have done to bring this project to fruition in a timely manner while providing guidance and expertise. Table of Contents List of Tables ..................................................................................................................... iv List of Figures ......................................................................................................................v Section 1: Overview of the Evidence-Based Project ...........................................................1 Introduction ....................................................................................................................1 Problem Statement .................................................................................................. 1 Purpose Statement and Project Objectives/Aims .................................................... 2 Significance/Relevance to Practice ......................................................................... 3 Project Question ...................................................................................................... 3 Hypotheses and Null Hypotheses ........................................................................... 3 Evidence-Based Significance of the Project ........................................................... 4 Definitions of Terms ............................................................................................... 5 Summary ................................................................................................................. 5 Section 2: Review of Scholarly Evidence ............................................................................6 Overview of the Literature ...................................................................................... 6 Literature Search ..................................................................................................... 6 Summary of Literature Review ............................................................................... 7 Alarm Notification Systems .................................................................................... 8 Review of Two Studies Focused on Alarm Fatigue ............................................... 9 Key Evidence for the EBP Project ........................................................................ 11 Overview of Theories Considered for Use in Studying Alarm Associated Practice Problems...................................................................................... 12 i Conceptual Model ................................................................................................. 13 Summary ............................................................................................................... 16 Section 3: Approach ...........................................................................................................18 Project Design/Methods ........................................................................................ 18 Setting and Sampling ............................................................................................ 18 Data Collection ..................................................................................................... 19 Study Interventions/Protocols ............................................................................... 20 Data Analysis ........................................................................................................ 23 Project Evaluation Plan ......................................................................................... 24 Summary ............................................................................................................... 24 Section 4: Findings, Discussion, and Implications ............................................................25 Summary and Evaluation of Findings................................................................... 25 Discussion ............................................................................................................. 29 Implications........................................................................................................... 30 Project Strengths and Limitations ......................................................................... 33 Analysis of Self ..................................................................................................... 34 Summary and Conclusions ................................................................................... 36 Section 5: Scholarly Product – Sample Paper for Presentation .........................................38 Introduction ........................................................................................................... 38 The Problem .......................................................................................................... 38 Purpose Statement and Project Objectives/Aims .................................................. 39 Significance/Relevance to Practice ....................................................................... 40 ii Project Question .................................................................................................... 40 Hypotheses and Null Hypotheses ......................................................................... 40 Evidence-Based Significance of the Project ......................................................... 41 Definition of Terms............................................................................................... 42 Conceptual Model ................................................................................................. 42 Project Design/Methods ........................................................................................ 45 Setting and Sampling ............................................................................................ 45 Project Evaluation Plan ......................................................................................... 46 Findings and Discussion ....................................................................................... 47 Implications........................................................................................................... 48 Summary and Conclusions ................................................................................... 51 References ..........................................................................................................................52 Appendix A: Alarm Definitions for Conceptual Model ....................................................56 Appendix B: Summary of Analyzed Articles ....................................................................58 Appendix C: Room Numbering for Data Collection .........................................................61 Appendix D: Project Assistant Orientation........................................................................62 Appendix E: Alarm Observation Data Collection Sheet – Preintervention .......................64 Appendix F: Alarm Observation Data Collection Sheet – Postintervention .....................65 Appendix G: Range, Median, and Mode for Alarm Observation Data .............................66 iii
Description:The list of books you might like
